Johanna Hissbach

Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both - a multi-center study.

BACKGROUND The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse. METHODS Of the 459 participants (59.7% male) 182 (39.7%) were alcohol-dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD. RESULTS Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9+/-8.8; group D: 12.9+/-11.7; group AD: 15.1+/-11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders. CONCLUSIONS It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma.

Impact of Childhood Trauma on Hypothalamus-Pituitary-Adrenal Axis Activity in Alcohol-Dependent Patients

Aims: Studies in animals and humans suggest that early life stress alters hypothalamus-pituitary-adrenal (HPA) axis activity. The same alterations are related to the symptoms and course of alcohol dependence. This study examined relationships between childhood trauma and HPA axis activity in alcohol-dependent patients controlling for psychopathology and characteristics of dependence. Methods: Thirty-eight consecutive patients (42% female) were examined at admission to detoxification (t1) and 14 days later (t2). Morning plasma levels of cortisol and adrenocorticotropin-releasing hormone (ACTH) were determined. Participants completed the Childhood Trauma Questionnaire (CTQ) and measures of anxiety, depression, and posttraumatic stress disorder. Results: Sexual abuse was related to higher levels of cortisol during acute withdrawal (r = 0.38, p = 0.02). Levels of ACTH were negatively correlated with the CTQ total score (t2: r = –0.42, p < 0.01), emotional abuse (t2: r = –0.33, p = 0.04), emotional neglect (t2: r = –0.33, p = 0.04), and physical neglect (t2: r = –0.33, p = 0.05) controlling for psychopathology and characteristics of dependence. Conclusions: Our findings suggest, that childhood trauma is related to blunted ACTH and increased cortisol during withdrawal in alcohol-dependent patients. Early life stress might be a confounding variable in studies of HPA function in alcohol dependence and future studies should examine potential clinical consequences of these relationships.

Dimensionality and predictive validity of the HAM-Nat, a test of natural sciences for medical school admission

BackgroundKnowledge in natural sciences generally predicts study performance in the first two years of the medical curriculum. In order to reduce delay and dropout in the preclinical years, Hamburg Medical School decided to develop a natural science test (HAM-Nat) for student selection. In the present study, two different approaches to scale construction are presented: a unidimensional scale and a scale composed of three subject specific dimensions. Their psychometric properties and relations to academic success are compared.Methods334 first year medical students of the 2006 cohort responded to 52 multiple choice items from biology, physics, and chemistry. For the construction of scales we generated two random subsamples, one for development and one for validation. In the development sample, unidimensional item sets were extracted from the item pool by means of weighted least squares (WLS) factor analysis, and subsequently fitted to the Rasch model. In the validation sample, the scales were subjected to confirmatory factor analysis and, again, Rasch modelling. The outcome measure was academic success after two years.ResultsAlthough the correlational structure within the item set is weak, a unidimensional scale could be fitted to the Rasch model. However, psychometric properties of this scale deteriorated in the validation sample. A model with three highly correlated subject specific factors performed better. All summary scales predicted academic success with an odds ratio of about 2.0. Prediction was independent of high school grades and there was a slight tendency for prediction to be better in females than in males.ConclusionsA model separating biology, physics, and chemistry into different Rasch scales seems to be more suitable for item bank development than a unidimensional model, even when these scales are highly correlated and enter into a global score. When such a combination scale is used to select the upper quartile of applicants, the proportion of successful completion of the curriculum after two years is expected to rise substantially.

Attitudes of patients with schizophrenia and depression to psychiatric research: a study in seven European countries

BackgroundRelatively few studies have examined how patients with schizophrenia and depression view psychiatric research and what influences their readiness to participate.MethodsA total of 763 patients (48% schizophrenia, 52% depression) from 7 European countries were examined using a specifically designed self-report questionnaire [“Hamburg Attitudes to Psychiatric Research Questionnaire” (HAPRQ)].ResultsMost patients (98%) approved of psychiatric research, in general, at least “a little”. There was a tendency to approve psychosocial rather than biological research topics (e.g. research on the role of the family by 91% of patients compared to 79% in genetics). Reasons to participate were mainly altruistic. Only a minority (28%) considered monetary incentives important. Patients wanted extensive background information and a feedback of the results; both were significantly more expressed by schizophrenia as compared to depressive patients, although these findings need to be interpreted with care because of age and gender differences between the diagnostic groups.ConclusionWhile patients expressed discerning views of psychiatric research, only few differences were apparent between the two diagnostic groups. Patients’ research priorities are not the same as those of many professionals and funding bodies. Their demonstrated critical appraisal should inform future research ensuring an increased patient role in the research process.

Wer wird ein guter Arzt

ZusammenfassungSeit 2005 können die deutschen Universitäten etwa 60% ihrer Medizin- und Zahnmedizinstudienplätze nach selbst gewählten Verfahren vergeben. 2008 ergaben die Auswahlverfahren ein buntes Bild: Einige Universitäten verwendeten ausschließlich die Abiturnote, andere zogen zusätzlich in unterschiedlicher Kombination Auswahlgespräche, Testverfahren, absolvierte Berufsausbildung oder Belege für wissenschaftliches, kulturelles oder soziales Engagement hinzu. Lediglich für die Abiturnote und einige Studierfähigkeitstests zeigen viele Studien eine akzeptable prognostische Validität zumindest in Bezug auf den Studienerfolg. Die Validität von Auswahlgesprächen oder anderen Merkmalen zur Messung nichtkognitiver Merkmale konnte nicht hinreichend belegt werden. In aktuellen Studien an den Medizinischen Fakultäten Hamburg und Heidelberg werden Prädiktoren wie ein Naturwissenschaftstest, die Abiturnote oder eine abgeschlossene Berufsausbildung beziehungsweise ein freiwilliges soziales Jahr auf ihre prognostische Validität untersucht. Wir empfehlen, in Auswahlverfahren neben der Abiturnote auch die Ergebnisse studienfachspezifischer schriftlicher, in der Zahnmedizin auch praktischer Tests, zu verwenden. Auswahlgespräche könnten sinnvoll sein, um Studienbewerbern die Wichtigkeit nichtkognitiver Eigenschaften zu vermitteln und sie stärker an die Fakultät zu binden.AbstractSince 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.Since 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.

Prediction of practical performance in preclinical laboratory courses – the return of wire bending for admission of dental students in Hamburg

Although some recent studies concluded that dexterity is not a reliable predictor of performance in preclinical laboratory courses in dentistry, they could not disprove earlier findings which confirmed the worth of manual dexterity tests in dental admission. We developed a wire bending test (HAM-Man) which was administered during dental freshmen’s first week in 2008, 2009, and 2010. The purpose of our study was to evaluate if the HAM-Man is a useful selection criterion additional to the high school grade point average (GPA) in dental admission. Regression analysis revealed that GPA only accounted for a maximum of 9% of students’ performance in preclinical laboratory courses, in six out of eight models the explained variance was below 2%. The HAM-Man incrementally explained up to 20.5% of preclinical practical performance over GPA. In line with findings from earlier studies the HAM-Man test of manual dexterity showed satisfactory incremental validity. While GPA has a focus on cognitive abilities, the HAM-Man reflects learning of unfamiliar psychomotor skills, spatial relationships, and dental techniques needed in preclinical laboratory courses. The wire bending test HAM-Man is a valuable additional selection instrument for applicants of dental schools.

[Who will be a good physician? : Admission procedures for medical and dental students.]

ZusammenfassungSeit 2005 können die deutschen Universitäten etwa 60% ihrer Medizin- und Zahnmedizinstudienplätze nach selbst gewählten Verfahren vergeben. 2008 ergaben die Auswahlverfahren ein buntes Bild: Einige Universitäten verwendeten ausschließlich die Abiturnote, andere zogen zusätzlich in unterschiedlicher Kombination Auswahlgespräche, Testverfahren, absolvierte Berufsausbildung oder Belege für wissenschaftliches, kulturelles oder soziales Engagement hinzu. Lediglich für die Abiturnote und einige Studierfähigkeitstests zeigen viele Studien eine akzeptable prognostische Validität zumindest in Bezug auf den Studienerfolg. Die Validität von Auswahlgesprächen oder anderen Merkmalen zur Messung nichtkognitiver Merkmale konnte nicht hinreichend belegt werden. In aktuellen Studien an den Medizinischen Fakultäten Hamburg und Heidelberg werden Prädiktoren wie ein Naturwissenschaftstest, die Abiturnote oder eine abgeschlossene Berufsausbildung beziehungsweise ein freiwilliges soziales Jahr auf ihre prognostische Validität untersucht. Wir empfehlen, in Auswahlverfahren neben der Abiturnote auch die Ergebnisse studienfachspezifischer schriftlicher, in der Zahnmedizin auch praktischer Tests, zu verwenden. Auswahlgespräche könnten sinnvoll sein, um Studienbewerbern die Wichtigkeit nichtkognitiver Eigenschaften zu vermitteln und sie stärker an die Fakultät zu binden.AbstractSince 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.Since 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.

Suitability of the HAM-Nat test and TMS module "basic medical-scientific understanding" for medical school selection

Aims: Tests with natural-scientific content are predictive of the success in the first semesters of medical studies. Some universities in the German speaking countries use the ‘Test for medical studies’ (TMS) for student selection. One of its test modules, namely “medical and scientific comprehension”, measures the ability for deductive reasoning. In contrast, the Hamburg Assessment Test for Medicine, Natural Sciences (HAM-Nat) evaluates knowledge in natural sciences. In this study the predictive power of the HAM-Nat test will be compared to that of the NatDenk test, which is similar to the TMS module “medical and scientific comprehension” in content and structure. Methods: 162 medical school beginners volunteered to complete either the HAM-Nat (N=77) or the NatDenk test (N=85) in 2007. Until spring 2011, 84.2% of these successfully completed the first part of the medical state examination in Hamburg. Via different logistic regression models we tested the predictive power of high school grade point average (GPA or “Abiturnote”) and the test results (HAM-Nat and NatDenk) with regard to the study success criterion “first part of the medical state examination passed successfully up to the end of the 7th semester” (Success7Sem). The Odds Ratios (OR) for study success are reported. Results: For both test groups a significant correlation existed between test results and study success (HAM-Nat: OR=2.07; NatDenk: OR=2.58). If both admission criteria are estimated in one model, the main effects (GPA: OR=2.45; test: OR=2.32) and their interaction effect (OR=1.80) are significant in the HAM-Nat test group, whereas in the NatDenk test group only the test result (OR=2.21) significantly contributes to the variance explained. Conclusions: On their own both HAM-Nat and NatDenk have predictive power for study success, but only the HAM-Nat explains additional variance if combined with GPA. The selection according to HAM-Nat and GPA has under the current circumstances of medical school selection (many good applicants and only a limited number of available spaces) the highest predictive power of all models.

Wer wird ein guter Arzt?@@@Who will be a good physician?: Verfahren zur Auswahl von Studierenden der Human- und Zahnmedizin@@@Admission procedures for medical and dental students

ZusammenfassungSeit 2005 können die deutschen Universitäten etwa 60% ihrer Medizin- und Zahnmedizinstudienplätze nach selbst gewählten Verfahren vergeben. 2008 ergaben die Auswahlverfahren ein buntes Bild: Einige Universitäten verwendeten ausschließlich die Abiturnote, andere zogen zusätzlich in unterschiedlicher Kombination Auswahlgespräche, Testverfahren, absolvierte Berufsausbildung oder Belege für wissenschaftliches, kulturelles oder soziales Engagement hinzu. Lediglich für die Abiturnote und einige Studierfähigkeitstests zeigen viele Studien eine akzeptable prognostische Validität zumindest in Bezug auf den Studienerfolg. Die Validität von Auswahlgesprächen oder anderen Merkmalen zur Messung nichtkognitiver Merkmale konnte nicht hinreichend belegt werden. In aktuellen Studien an den Medizinischen Fakultäten Hamburg und Heidelberg werden Prädiktoren wie ein Naturwissenschaftstest, die Abiturnote oder eine abgeschlossene Berufsausbildung beziehungsweise ein freiwilliges soziales Jahr auf ihre prognostische Validität untersucht. Wir empfehlen, in Auswahlverfahren neben der Abiturnote auch die Ergebnisse studienfachspezifischer schriftlicher, in der Zahnmedizin auch praktischer Tests, zu verwenden. Auswahlgespräche könnten sinnvoll sein, um Studienbewerbern die Wichtigkeit nichtkognitiver Eigenschaften zu vermitteln und sie stärker an die Fakultät zu binden.AbstractSince 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.Since 2005, German universities are free to select 60% of their freshmen according to their own admission processes. In 2008, selection of medical students in Germany was mainly based on grades achieved in final school examinations (Abiturnote). Further criteria were used in various combinations: some medical schools conducted interviews or tests, while others rewarded work experience, research awards, or cultural and social dedication. However, solely high school grades and some measures of ability show acceptable validity coefficients with regard to academic and professional success. Evidence for the prognostic validity of interviews and other noncognitive criteria cannot be regarded as sufficient. Recent studies conducted in Hamburg and Heidelberg attempt to validate selection criteria such as a test of natural sciences, final school examination grades, work experience, and voluntary work in the social sector. For the selection of medical students, we recommend the use of final school examination grades in combination with special written test results or, in the case of dentistry, a test of manual dexterity. Interviews might be beneficial to emphasize the importance of non-academic skills and to strengthen the ties of students to their faculty.